冠心病与缺血性心脏病介绍

Pathophysiology
Atheroma/Atherosclerosis
Diffused disease of the arterial wall Coronary artery at high risk Cerebral / peripheral vascular disease often
Epidemiology
Most common form of heart disease
Single most important cause of premature death
Epidemiology -- USA
1/2 deaths (1/2million) 1.5 million MI each year 45% MI under age 65 50-100 billion $ per year
Soldiers died in the korean war
300 Cases autopsy (age, 22.1y)
77.3% atherosclerosis
39%
occlusive plaque
ENOS JAMA 1953
Incidence of atherosclerosis in donor heart
Mature Fibrolipid Plaque
Lipid core Surrounded by SMC Fibrous cap
Pathophysiology
Plague Rupture / Fissure Thrombosis + Local spasm Vessel Occlusion
ACS
Pathophysiology Plaque Rupture
3.2
21.3
22.5 22.3
He J & Gu D, et al, N Engl J Med 2005;353;11:1124-34
Heart diseases Cancer Stroke Pneumonia & influenza Infectious diseases Accidents COPD Chronic liver disease Diabetes mellitus Others
Eastern Europe Many developing countries
China India
Proportionate Mortality for the Ten Leading Causes of Death in China, 1991-2001
20.1
1.5 1.5 1.8 2.8 3.1
Epidemiology -- UK
One in 4 men/one in 5 women die from CHD 300 000 people have MI each year 1.7 million people have angina
Epidemiology
The incidence of CHD
coexist Radial / Internal mammary artery largely
spared
Pathophysiology Plaque Formation 1
Plaques begin to appear in 2nd and 3rd decade of life The nature/composition of plaques changes
Pathophysiology Plaque Formation 2
Pathophysiology Plaque Formation 3
Fatty streaks develope
Circulating Monocytes
migrate into intima take-up oxidised LDL from plasma
Incedence of ather (%)
EEM Area 13.2 mm2
5.07 mm2
Atheroma Area 8.13 mm2
Female,32y
100 85%
80
71%
ቤተ መጻሕፍቲ ባይዱ
60% 60
40
37%
20 17%
0 <20 20-2930-3940-49 ≥50
age (y)
Tuzcu Circ 1999
Pathophysiology
Almost always due to athroma and its complications particularly thrombosis
Pathophysiology
Occasionally other disorders
• Congenital anomalies • Anomalous origin • Fistular/Malformation of a major coronary artery • Aortitis • Polyarteritis • Connective tissue disorders
Smooth muscle cells migrate into proliferate within Plaque
Pathophysiology Plaque Formation 6
Lesion Grows
Encroaches into lumen
Erodes media
Pathophysiology Plaque Formation 7
become lipid-laden foam cells
Pathophysiology Plaque Formation 4
Lipid Pool
Foam cells die The contents release
Pathophysiology Plaque Formation 5
Early Atheroma
Coronary (Ischemic) Heart Disease
冠心病和缺血性心脏病介 绍
CHD
Epidemiology Pathophysiology Risk factors and Prevention Clinical manifestation,Diagnosis and
management